Chronic non-communicable disease as a new epidemic in Africa: focus on The Gambia

Knowledge of diabetes among Gambian adults: evidence from a nation-wide survey

Background

Diabetes is increasingly becoming a public health problem in developing countries like The Gambia. Prevention of diabetes and appropriate management of the disease largely depends on correct knowledge of the risk factors and signs and symptoms of the condition. However, studies that have assessed knowledge of diabetes at population level are limited. We examined the knowledge of diabetes risk factors, and signs and symptoms among Gambian adults.

Methods

The 2019–2020 Gambia demographic and health survey data was used to analyze 4, 436 men and 6, 186 women. Knowledge of diabetes was assessed two-fold: (1) diabetes risk factors and (2) diabetes signs and symptoms. Several sociodemographic factors were considered for analysis. A generalized estimating equation model was fitted to test the association between the selected sociodemographic factors and diabetes knowledge.

Results

Among the men, 7.6% and 3.1% had knowledge about diabetes risk factors, and signs and symptoms, respectively. Approximately 3.1% and 1.2% of the women included in the analysis had knowledge of diabetes risk factors, and signs and symptoms, respectively. Men who were aged ≥ 35 years were more likely to have knowledge regarding diabetes risk factors (adjusted odds ratio (AOR) = 1.90, 95% confidence interval (CI) = 1.12–3.22), and signs and symptoms (AOR = 2.59, 95% CI = 1.08–6.17). Having access to media was associated with increased odds of having knowledge regarding diabetes risk factors (AOR = 1.61, 95% CI = 1.09–2.37) and signs and symptoms (AOR = 2.04, 95% CI = 1.07–3.88) among men. Among other factors, educational level was positively associated with having diabetes knowledge among both men and women. Heterogeneities regarding diabetes knowledge were observed among different regions and areas of residence.

Conclusion

There is a need to improve awareness regarding diabetes in The Gambia as low knowledge has been observed. Programs aimed to improve diabetes knowledge should consider regional and area of residence variations in their designs. The use of mass media and strengthening the education sector in The Gambia may be of importance in raising diabetes knowledge among Gambian adults.

Is the Duration of Diabetes Diseases Positively Associated With Knowledge About Diabetic Complications? Knowledge of Diabetes Mellitus Complications and Associated Factors Among Type-2 Diabetic Patients in Public Hospitals of Addis Ababa, 2020

Background

Although the importance of educational programs in the prevention and control of diabetes mellitus (DM) and its complication is well-recognized, there are concerns about whether these programs are achieving the desired goal of increasing knowledge of DM and its complication in developing countries. Therefore, this study assessed knowledge of DM complications and associated factors among type-2 diabetic patients in public hospitals of Addis Ababa.

Method

Simple random sampling technique was used to select 422 participants. Data were entered to EpiData Version 4.6.0.1 and analyzed using SPSS Version 25 software. Multicollinearity and model goodness-of-fit was checked. A multivariate logistic regression model at 95% CI was used to identify the predictors.

Result

The overall knowledge of diabetes complications among diabetic patients in the Hospitals of Addis Ababa was 54.9%. In the fitted model, being a profession of governmental workers [adjusted odds ratio (AOR) = 3.12, 95% CI (1.33, 7.34)] and merchants [AOR = 2.54, 95% CI (1.16, 5.56)]; DM duration 5–10 years [AOR = 0.41, 95% CI (0.23, 0.73)] and ≥10 years [AOR = 0.36, 95% CI (0.19, 0.69)]; family history of DM [AOR = 1.68, 95% CI (1.03, 2.75)]; and participating in diabetic counseling [AOR = 2.41, 95% CI (1.50, 3.86)] were significantly associated with knowledge about DM complications.

Conclusion and Recommendation

The overall knowledge of diabetes complications among diabetic patients in the Hospitals of Addis Ababa was 54.9%. It was determined by the duration of DM, current profession, family history, and participation in diabetes counseling. Hence, emphasis on sustaining knowledge about diabetes complications for patients who are more than 5 years since diagnosis and attention is needed about knowledge diabetic farmers.

Descriptive cross-sectional study on knowledge, awareness and adherence to medication among hypertensive patients in a tertiary care center, Eastern Sri Lanka

Introduction:

Hypertension is one of the common non-communicable diseases and public health problem among developed and developing countries. The lack of knowledge and awareness on hypertension and poor adherence of medication are a major challenge to control hypertension and prevent its complications. Our study aimed to assess the knowledge, awareness of hypertension and adherence to medication among hypertensive patients attending the medical clinics of a tertiary care center, Eastern Province of Sri Lanka.

Methods:

A descriptive cross-sectional study was conducted among hypertensive patients to assess knowledge, awareness of hypertension and adherence to medication in medical clinics in a tertiary care for 6 months duration. Data were collected by using pretested and validated Hypertension Facts Questionnaire. Their medication adherence and the reasons for nonadherence were studied using Medication Adherence Scale. Data were analyzed using SPSS (version 18) analytical package and the chi-square test was performed. The scoring system was used to categorize the level of knowledge and awareness of hypertension among patients.

Results:

The majority of patients had moderate-to-high knowledge (101, 65.8%) about hypertension and had moderate-to-high awareness (111, 73.2%) on hypertension. Even though, 134 (87.6%) patients knew that they have hypertension, and 108 (70.6%) patients did not know their blood pressure value at the time of diagnosis. Most of the patients (90, 58.8%) had good drug adherence, and most of them (141, 92.1%) thought that taking medicine plays a key role to control their blood pressure. The main reasons for nonadherence of medication were forgetfulness (39, 32%) and expenses (46, 35.4%). The knowledge and awareness about hypertension among respondents were significantly associated with educational level (p < 0.05)

Conclusion:

Most of the patients had adequate knowledge on the risk factors and complications of hypertension. But they were unaware about their disease status, and their diagnosis, target organ damage and recent blood pressure values. The drug adherence was reasonably adequate. The main reasons for nonadherence of medication were forgetfulness and expenses.

Prevalence and correlates of multimorbidity among adults in Botswana: A cross-sectional study

BACKGROUND

Botswana is currently undergoing rapid epidemiological transition indicated by a decline in infectious diseases and an increase in chronic non-communicable diseases and their associated risk factors. The main aim of this study was to assess prevalence and correlates of multimorbidity among the adult population in Botswana.

METHODS

A cross-sectional study called Chronic Non-Communicable Diseases Study (NCDs study) was conducted in March, 2016. Using multistage cross sectional sampling design, 1178 male and female respondents aged 15 years and above were interviewed across 3 cities and towns, 15 urban villages and 15 rural villages. Participants were interviewed face-to-face using a structured questionnaire. Adjusted multinomial logistic regression analysis was used to assess covariates of multimorbidity. The statistical significant level was fixed at p <0 .05.

RESULTS

Prevalence of multimorbidity in the sampled population was estimated at 5.4%. Multivariate results indicate that the odds of multimobridty were significantly high among women (AOR = 3.34, 95% C.I. = 1.22-21.3) than men. On the other hand, the odds of multimorbidity were significantly low among young people aged below 24 years (AOR = 0.01, 95% C.I. = 0.00-0.07), currently married people (AOR = 0.24, 95% C.I. = 0.07-0.80) and individuals in the 2nd wealth quintile (AOR = 0.20, 95% C.I. = 0.05-0.75) compared to their counterparts. For behavioural risk factors, alcohol consumption (AOR = 4.80, 95% C.I. = 1.16-19.8) and overweight/obesity (AOR = 1.44, 95% CI = 1.12-2.61) were significantly associated with high multimorbidity prevalence.

CONCLUSION

Multimorbidity was found to be more prevalent among women, alcohol consumers and overweight/obese people. There is need to strengthen interventions encouraging healthy lifestyles such as non-consumption of alcohol, physical activity and healthy diets. Moreover, there is need for a holistic approach of health care services to meet the needs of those suffering from multimorbidity.

A review of policies and programmes for human organ and tissue donations and transplantations, WHO African Region

Several resolutions, endorsed by the World Health Assembly and the United Nations General Assembly, articulate the need to improve the availability, quality and safety of organ and tissue donation and transplantation, as well as to prevent and combat trafficking in human organs. Here we assessed the implementation of these resolutions pertaining to organ and tissue donations and transplantations by sending out a questionnaire to all 47 countries in the World Health Organization African Region. From 33 countries that provided data, we identified several obstacles and challenges. Compared to other regions, there are very limited data on organ donation and transplantation. Most countries are lacking legal and regulatory frameworks, since they did not yet establish a specific or comprehensive legislation covering donation and transplantation of human organs and tissues. Countries also have a poor national capacity to perform organ and tissue transplantations and the organization and management of national programmes are weak. Funding, both from domestic and external sources, is insufficient to implement effective transplantations programmes and patients have inadequate financial protection. To address these challenges, we propose that countries and partners should develop and implement policies, strategies, plans and regulatory frameworks for all aspects of organ and tissue donations and transplantations, including fighting against organ trafficking and transplant tourism. Where donation and transplantation programmes exist, stakeholders should develop the skills of human resources, adopt technical standards and quality management procedures to improve donation and transplantation of human organs and tissues.

[Non-communicable diseases in Southern Tunisia: morbidity, mortality profile and chronological trends]

OBJECTIVES

Non-communicable diseases (NCDs) represent a major public health problem worldwide. Giving their impact on the morbidity and mortality burden, understanding their chronological trends over time is a priority for epidemiological surveillance. We aimed to determine the epidemiological specificities of NCDs and to study their chronological trends over the period&#160;2010-2015.

METHODS

We retrospectively collected data of hospitalized&#160;patients from the regional registry of morbidity and mortality in the Southern University Hospital of Tunisia during the period 2010-2015.

RESULTS

We included 18,081 patients with NCDs aged ≥ 25 years. The distribution of NCDs was characterized by the predominance of cardiovascular disease (CVD) (10,346 cases, 57.2%). Chronological trends analysis of NCDs showed that NCDs remained globally stable between 2010 and 2015. The same result applied to the group of cancers, chronic respiratory diseases and diabetes mellitus. However, CVD increased significantly between 2010 and 2015 (ρ = 0.84; p = 0.036). The proportion of CVD increased significantly among men (ρ = 0.87; p = 0.019) and elderly (ρ = 0.88; p = 0.019). The hospital mortality rate of NCDs increased significantly (ρ = 0.85; p = 0.031), notably for CVDs (ρ = 0.94; p = 0.005).

CONCLUSION

Chronological trends analysis revealed a significant rise in the morbidity and mortality burden of CVDs during the period 2010-2015. It is imperative, therefore, to strengthen health care for these&#160;patients and to introduce the concept of integrated NCDs prevention as an essential component of the health system.

Knowledge, attitude and practice regarding hypertension among residents in a housing area in Selangor, Malaysia

Background and aims

Hypertension is becoming a global epidemic and threat to the world population. This cross-sectional study was carried out at a housing area in Selangor, Malaysia to study the knowledge, attitude and practice (KAP) regarding hypertension among the residents.

Methods

A total of 110 respondents aged 18 years old and above were selected by convenience sampling. Data was collected using a structured interviewer-guided questionnaire with Likert-scale choices of answers.

Results

All respondents were Malay with the mean age of 41 years [Standard Deviation (SD)=11.828]. The total mean and SD of knowledge, attitude and practice scores were 74.33 (SD=6.25), 44.22 (SD=5.05) and 27.55 (SD=2.86), respectively. There were significant positive correlations between knowledge with attitude (r=+0.393; p<0.001) and practice (r=+0.378; p<0.001). However, there was no significant correlation between attitude and practice (r=+0.120; p=0.212). There were significant fair positive correlations between age with knowledge (r=+0.402; p<0.001), attitude (r=+0.265; p=0.005) and practice (r=+0.337; p<0.001) regarding hypertension. Meanwhile, gender, educational level, employment status and family history had no significant association with knowledge, attitude and practice regarding hypertension.

Conclusion

This study revealed that KAP regarding hypertension were associated with age, but not with other socio-demographic characteristics studied. The awareness, prevention and control programs of hypertension in their community should be increased, so that the residents could enjoy and maintain the healthy lifestyle.

Incidence and Outcomes after Out-of-Hospital Medical Emergencies in Gambia: A Case for the Integration of Prehospital Care and Emergency Medical Services in Primary Health Care

BACKGROUND

The Gambia is going through a rapid epidemiologic transition with a dual disease burden of infections and non-communicable diseases occurring at the same time. Acute, time-sensitive, medical emergencies such as trauma, obstetric emergencies, respiratory failure, and stroke are leading causes of morbidity and mortality among adults in the country.ProblemData on medical emergency care and outcomes are lacking in The Gambia. Data on self-reported medical emergencies among adults in a selection of Gambian communities are presented in this report.

METHODS

A total of 320 individuals were surveyed from 34 communities in the greater Banjul area of The Gambia using a survey instrument estimating the incidence of acute medical emergencies in an adult population. Self-reported travel time to a health facility during medical emergencies and patterns of health-seeking behavior with regard to type of facility visited and barriers to accessing emergency care, including cost and medical insurance coverage, are presented in this report.

RESULTS

Of the 320 individuals surveyed, 262 agreed to participate resulting in a response rate of 82%. Fifty-two percent of respondents reported an acute medical emergency in the preceding year that required urgent evaluation at a health facility. The most common facility visited during such emergencies was a health center. Eighty-seven percent of respondents reported a travel time of less than one hour during medical emergencies. Out-of-pocket cost of medications accounted for the highest expenditure during emergencies. There was a low awareness and willingness to subscribe to health insurance among individuals surveyed.

CONCLUSION

There is a high incidence of acute medical emergencies among adults in The Gambia which are associated with adverse outcomes due to a combination of poor health literacy, high out-of-pocket expenditures on medications, and poor access to timely prehospital emergency care. There is an urgent need to develop prehospital acute care and Emergency Medical Services (EMS) in the primary health sector as part of a strategy to reduce mortality and morbidity in the country. TourayS, SanyangB, ZandrowG, TourayI. Incidence and outcomes after out-of-hospital medical emergencies in Gambia: a case for the integration of prehospital care and Emergency Medical Services in primary health care. Prehosp Disaster Med. 2018;33(6):650-657.

Prevalence and predictors of physical inactivity levels among Kenyan adults (18-69 years): an analysis of STEPS survey 2015

BACKGROUND

Physical inactivity accounts for more than 3 million deaths worldwide, and is implicated in causing 6% of coronary heart diseases, 7% of diabetes, and 10% of colon or breast cancer. Globally, research has shown that modifying four commonly shared risky behaviours, including poor nutrition, tobacco use, harmful use of alcohol, and physical inactivity, can reduce occurrence of non-communicable diseases (NCDs). Risk factor surveillance through population-based periodic surveys, has been identified as an effective strategy to inform public health interventions in NCD control. The stepwise approach to surveillance (STEPS) survey is one such initiative, and Kenya carried out its first survey in 2015. This study sought to describe the physical inactivity risk factors from the findings of the Kenya STEPS survey.

METHODS

This study employed countrywide representative survey administered between April and June 2015. A three stage cluster sampling design was used to select clusters, households and eligible individuals. All adults between 18 and 69 years in selected households were eligible. Data on demographic, behavioural, and biochemical characteristics were collected. Prevalence of physical inactivity was computed. Logistic regression used to explore factors associated with physical inactivity.

RESULTS

A total of 4500 individuals consented to participate from eligible 6000 households. The mean age was 40.5 (39.9-41.1) years, with 51.3% of the respondents being female. Overall 346 (7.7%) of respondents were classified as physically inactive. Physical inactivity was associated with female gender, middle age (30-49 years), and increasing level of education, increasing wealth index and low levels of High Density Lipoproteins (HDL).

CONCLUSION

A modest prevalence of physical inactivity slightly higher than in neighbouring countries was found in this study. Gender, age, education level and wealth index are evident areas that predict physical inactivity which can be focused on to develop programs that would work towards reducing physical inactivity among adults in Kenya.

[Active smoking: A major risk factor for human non-communicable diseases in a hospital survey]

INTRODUCTION

Tobacco is the main preventable cause of death worldwide. Our study aimed to determine the role of tobacco in the occurrence of non-communicable diseases (NCDs).

METHODS

We conducted a retrospective study including all NCDs patients during 2015-2016. NCDs include cardiovascular diseases (CVD), chronic respiratory diseases (CRD), cancers (CS) and diabetes mellitus (DM).

RESULTS

We identified 3643 cases of NCDs (43%) among 8478 hospitalizations, all diseases combined. Active smoking was found in 1076 cases (29.5%). Among the NCDs groups, CVD was the most common (65%). Tobacco was significantly associated with CVD (P<0.001), CRD (P=0.002), bronchopulmonary CS (P<0.001), haematological malignancy (P=0.023), and DM (P<0.001). Multivariate analysis performing binary logistic regression revealed that tobacco was an independent factor associated with CVD (OR=2.6, P<0.001), CRD (OR=1.5, P<0.001), bronchopulmonary CS (OR=1.8, P=0.013) and DM (OR=3.6, P<0.001).

CONCLUSION

Active smoking was a major risk factor in the occurrence of NCDs. Thus, smoking cessation represents the cornerstone for preventing the spread of these diseases, especially in countries with limited resources.

Burden of NCDs in SNNP region, Ethiopia: a retrospective study

Background

Non-communicable diseases (NCDs) are medical conditions or diseases that are non-transmissible. As NCDs are becoming one of major public health problem, providing local description of diseases and injuries is key to health decision- making and planning processes. So, this study aimed to describe caseload of NCDs in Southern Nations Nationalities and People’s Region, Ethiopia.

Methods

A facility based retrospective study was conducted in February 2015 in SNNPR, Ethiopia. A total of 22,320 records of three years retrieved from 23 health facilities using systematic sampling. Data were entered in to Epi-Info 3.5.3 and descriptive analysis was carried out using SPSS version 20.

Results

From 22,320 records reviewed, 6633 (29.7%) clients visited health facilities due to Non-Communicable Diseases (NCDs). Majority (37.2%) of NCD cases were in productive age groups (20–35 year). Near to half (43%) of NCD cases were from rural and 45.8% were females. Digestive disorder (26.7%), cardiovascular diseases (18.8%) and Diabetes Mellitus (13.1%) were the most prevalent types of NCDs.

Conclusion

Health facilities are burdened with significant proportion of clients with NCDs. Young population accounts large share and NCDs are becoming public health problem of urban and rural area within a health care system that focus on communicable diseases. There is a need to strengthen the health system to work towards NCDs, and investigate risk factors associated with NCDs at individual level.

Occupational therapy and physiotherapy education and workforce in Anglophone sub-Saharan Africa countries

BACKGROUND

Sub-Saharan Africa (SSA) countries are faced with the challenge of educating a critical mass of occupational therapists (OTs) and physiotherapists (PTs) to meet the growing demand for health and rehabilitation services. The World Federation of Occupational Therapy (WFOT) and World Confederation of Physical Therapy (WCPT) have argued for the need of graduate-level training for OTs and PTs for decades. However, very few studies have been conducted to determine the availability of OT and PT training programs and practitioners in SSA countries.

METHODS

Initial data were collected and compiled from an extensive literature search conducted using MEDLINE and PubMed to examine the availability of OT and PT education and training programs in SSA countries. Additional data were collected, compiled, and collated from academic institutions, ministries of health, health professions associations, and licensing authorities in SSA countries. Secondary data were also collected from the websites of organizations such as the World Bank, World Health Organization (WHO), WFOT, and WCPT.

RESULTS

This investigation revealed that there are limited number of OT and PT training programs and that these training programs in Anglophone SSA countries are offered at or below the bachelor's level. More than half of the countries do not have OT or PT training programs. The number of qualified OTs and PTs appears to be insufficient to meet the demand for rehabilitation services. Nigeria and South Africa are the only countries offering post-entry-level masters and doctoral-level training programs in physiotherapy and occupational therapy.

CONCLUSIONS

Higher learning institutions in SSA countries need to collaborate and partner with other regional and foreign universities to elevate the educational training and increase the supply of PTs and OTs in the region.

Prevalence and correlates of self-reported chronic non-communicable diseases in Botswana: a cross-sectional study

BACKGROUND

The purpose of this paper is to estimate the prevalence of self-reported chronic non-communicable diseases and their correlates in Botswana. This is a nationally representative, cross-sectional survey.

METHODS

This is a cross-sectional study of respondents aged 10-64 years using data from the Botswana AIDS Impact Survey IV conducted in 2013. Three self-reported non-communicable diseases, namely, hypertension, diabetes and asthma were used. Multivariate logistic regression models were used to identify their correlates.

RESULTS

Out of the 2153 participants, the prevalence rates of hypertension, diabetes and asthma were 14.2%, 3.3% and 5.3%, respectively. The study found that among other factors, older populations are at a much higher risk of having more than one non-communicable disease. After controlling for other covariates, the ORs of self-reported non-communicable disease was highest among older respondents aged 50 years and over (AOR=12.01, p<0.001) followed by richer respondents (AOR=1.86, p≤0.025). The ORs were also higher among females (AOR=1.83, p<0.001) and urban village residents (AOR=1.41, p=0.038).

CONCLUSIONS

It is evident that chronic non-communicable diseases are likely to increase in the future due to the rise in the old age population resulting from fertility transition and improvement in life expectancy in Botswana. Therefore urgent and holistic intervention programmes are required to halt the problem. Failure to act now is likely to result in high morbidity and mortality.

Patterns and determinants of hypertension in Botswana

AIM

This study examines the patterns and determinants of hypertension in Botswana.

SUBJECTS AND METHODS

In 2007, a cross-sectional survey of chronic non-communicable diseases and risk factors was conducted by the Ministry of Health and World Health Organisation using the STEPS approach. STEP 1 was the collection of demographic data, STEP 2 was the physical measurement of the height, weight, waist and hips, and blood pressure; STEP 3 was biochemical measurements, which included the collection of blood samples. A nationally representative sample of 4003 individuals aged 25-64 years was included for analysis.

RESULTS

From a total sample of 4003 respondents, the national prevalence of hypertension was estimated to be 16.9 % (9.9 % for males versus 18.9 % for females). Logistic regression analysis indicated a positive association between gender and hypertension prevalence, with females (OR 1.9) more likely to be hypertensive. Hypertension increases significantly with age for both males and females. For women a high educational level and employment status were not associated with hypertension. Meanwhile, of all the behavioural risk factors, obesity was the only one with a significant association with hypertension.

CONCLUSION

The implications of this study are that a reduction in obesity through a balanced diet and increased physical activity will have far-reaching results in lowering hypertension. Botswana's health system should place greater emphasis on the detection of hypertension at early ages and create awareness programmes for both the general population and health personnel with respect to the detection, treatment and control of hypertension.

The Harbin Cohort Study on Diet, Nutrition and Chronic Non-communicable Diseases: study design and baseline characteristics

Diet and nutrition have been reported to be associated with many common chronic diseases and blood-based assessment would be vital to investigate the association and mechanism, however, blood-based prospective studies are limited. The Harbin Cohort Study on Diet, Nutrition and Chronic Non-communicable Diseases was set up in 2010. From 2010 to 2012, 9,734 participants completed the baseline survey, including demographic characteristics, dietary intake, lifestyles and physical condition, and anthropometrics. A re-survey on 490 randomly selected participants was done by using the same methods which were employed in the baseline survey. For all participants, the mean age was 50 years and 36% of them were men. Approximately 99.4 % of cohort members donated blood samples. The mean total energy intake was 2671.7 kcal/day in men and 2245.9 kcal/day in women, the mean body mass index was 25.7 kg/m² in men and 24.6 kg/m² in women, with 18.4% being obese (≥28 kg/m²), 12.7% being diabetic, and 29.5% being hypertensive. A good agreement was obtained for the physical measurements between the baseline survey and re-survey. The resources from the cohort and its fasting and postprandial blood samples collected both at baseline and in each follow-up will be valuable and powerful in investigating relationship between diet, nutrition and chronic diseases and discovering novel blood biomarkers and the metabolism of these biomarkers related to chronic diseases.

Self-reported prevalence of chronic non-communicable diseases and associated factors among older adults in South Africa

Introduction

Little is known about the prevalence and predictors of chronic non-communicable diseases (NCDs) of older adults in South Africa. This study aims to investigate the self-reported prevalences of major chronic NCDs and their predictors among older South Africans.

Methods

We conducted a national population-based cross-sectional survey with a sample of 3,840 individuals aged 50 years or above in South Africa in 2008. The outcome variable was the self-reported presence of chronic NCDs suffered, namely, arthritis, stroke, angina, diabetes, chronic lung disease, asthma, depression, and hypertension. The exposure variables were sociodemographic characteristics: age, gender, education, wealth status, race, marital status, and residence. Multivariate logistic regression was used to determine sociodemographic factors predictive of the presence of chronic NCDs.

Results

The prevalence of chronic NCDs was 51.8%. The prevalence of multimorbidity (≥2 chronic conditions) was 22.5%. Multivariate logistic regression analysis showed that being female, being in age groups 60–79 and 70–79, being Coloured or Asian, having no schooling, having greater wealth, and residing in an urban area were associated with the presence of NCDs.

Conclusion

The rising burden of chronic NCDs affecting older people places a heavy burden on the healthcare system as a result of increased demand and access to healthcare services. Concerted effort is needed to develop strategies for the prevention and management of NCDs, especially among economically disadvantaged individuals who need these services the most.

Physician emigration from sub-Saharan Africa to the United States: analysis of the 2011 AMA physician masterfile

BACKGROUND

The large-scale emigration of physicians from sub-Saharan Africa (SSA) to high-income nations is a serious development concern. Our objective was to determine current emigration trends of SSA physicians found in the physician workforce of the United States.

METHODS AND FINDINGS

We analyzed physician data from the World Health Organization (WHO) Global Health Workforce Statistics along with graduation and residency data from the 2011 American Medical Association Physician Masterfile (AMA-PM) on physicians trained or born in SSA countries who currently practice in the US. We estimated emigration proportions, year of US entry, years of practice before emigration, and length of time in the US. According to the 2011 AMA-PM, 10,819 physicians were born or trained in 28 SSA countries. Sixty-eight percent (n = 7,370) were SSA-trained, 20% (n = 2,126) were US-trained, and 12% (n = 1,323) were trained outside both SSA and the US. We estimated active physicians (age ≤ 70 years) to represent 96% (n = 10,377) of the total. Migration trends among SSA-trained physicians increased from 2002 to 2011 for all but one principal source country; the exception was South Africa whose physician migration to the US decreased by 8% (-156). The increase in last-decade migration was >50% in Nigeria (+1,113) and Ghana (+243), >100% in Ethiopia (+274), and >200% (+244) in Sudan. Liberia was the most affected by migration to the US with 77% (n = 175) of its estimated physicians in the 2011 AMA-PM. On average, SSA-trained physicians have been in the US for 18 years. They practiced for 6.5 years before US entry, and nearly half emigrated during the implementation years (1984-1999) of the structural adjustment programs.

CONCLUSION

Physician emigration from SSA to the US is increasing for most SSA source countries. Unless far-reaching policies are implemented by the US and SSA countries, the current emigration trends will persist, and the US will remain a leading destination for SSA physicians emigrating from the continent of greatest need. Please see later in the article for the Editors' Summary.

Physician emigration from sub-Saharan Africa to the United States: analysis of the 2011 AMA physician masterfile

BACKGROUND

The large-scale emigration of physicians from sub-Saharan Africa (SSA) to high-income nations is a serious development concern. Our objective was to determine current emigration trends of SSA physicians found in the physician workforce of the United States.

METHODS AND FINDINGS

We analyzed physician data from the World Health Organization (WHO) Global Health Workforce Statistics along with graduation and residency data from the 2011 American Medical Association Physician Masterfile (AMA-PM) on physicians trained or born in SSA countries who currently practice in the US. We estimated emigration proportions, year of US entry, years of practice before emigration, and length of time in the US. According to the 2011 AMA-PM, 10,819 physicians were born or trained in 28 SSA countries. Sixty-eight percent (n = 7,370) were SSA-trained, 20% (n = 2,126) were US-trained, and 12% (n = 1,323) were trained outside both SSA and the US. We estimated active physicians (age ≤ 70 years) to represent 96% (n = 10,377) of the total. Migration trends among SSA-trained physicians increased from 2002 to 2011 for all but one principal source country; the exception was South Africa whose physician migration to the US decreased by 8% (-156). The increase in last-decade migration was >50% in Nigeria (+1,113) and Ghana (+243), >100% in Ethiopia (+274), and >200% (+244) in Sudan. Liberia was the most affected by migration to the US with 77% (n = 175) of its estimated physicians in the 2011 AMA-PM. On average, SSA-trained physicians have been in the US for 18 years. They practiced for 6.5 years before US entry, and nearly half emigrated during the implementation years (1984-1999) of the structural adjustment programs.

CONCLUSION

Physician emigration from SSA to the US is increasing for most SSA source countries. Unless far-reaching policies are implemented by the US and SSA countries, the current emigration trends will persist, and the US will remain a leading destination for SSA physicians emigrating from the continent of greatest need. Please see later in the article for the Editors' Summary.